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The Society of Thoracic Surgeons (STS) has released clinical practice guidelines to address current and changing factors that affect the diagnosis and treatment of localized esophageal cancer. The guidelines, the first in a series, are published in the July issue of Annals of Thoracic Surgery (2013;96:346-356).


A news release notes that the Society's Workforce on Evidence Based Surgery, in consultation with the Workforce on General Thoracic Surgery, assembled a task force with the goal of addressing factors affecting treatment of localized esophageal cancer.


"With the emergence of imaging modalities, such as positron emission tomography (PET), and incorporation of minimally invasive surgical techniques, the STS Workforces recognized the need for a series of esophageal cancer guidelines to help clinicians in practice," said the corresponding author, Thomas K. Varghese Jr., MD, MS, Associate Professor of Surgery at the University of Washington.


"Diagnosis and staging are critical steps in the decision-making process for selection of optimal therapy, and hence a natural fit to be the first guidelines of this series."


Included are evidence-based recommendations for the use of computed tomography, PET, endoscopic ultrasound, endoscopic mucosal resection, and staging laparoscopy to assist with staging esophageal cancer. For diagnosis, the guidelines note that barium studies may help, but the primary recommendation is flexible endoscopy with biopsy.


"Quality, research, and patient safety initiatives are vital components of STS efforts to help provide the highest level of care for patients," Varghese said. "These clinical practice guidelines were developed as a resource for the health care team to help with these missions, advocating delivery of evidence-based best practices for all of our patients at all times."

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He noted that data show that for the past four decades the incidence of esophageal cancer in the United States has increased at the fastest rate of any solid tumor. Esophageal cancer is also one of the most lethal cancers, with an overall five-year survival rate of less than 15 percent.


In an accompanying editorial (Annals of Thoracic Surgery 2013;96:7), John D. Mitchell, MD, Chief of Thoracic Surgery at the University of Colorado, and Mark J. Krasna, MD, of Jersey Shore University Medical Center outlined the development process for the new guidelines and their importance to clinical practice.


"With the increasing incidence of esophageal cancer around the world, this disease has become even more important in the typical practice of the thoracic surgeon," the authors said. "This is a first attempt on the part of the thoracic surgical community to use evidence-based practices for the evaluation of esophageal cancer patients. It also sets a precedent for the surgeon to play a pivotal role in the assessment and management of patients with this dreaded disease."


The plan is for future clinical practice guidelines to review the evaluation and treatment of the continuum of Barrett's esophagus to early-stage esophageal cancer, the role of multimodality therapy in esophageal malignancy, and the choice of esophageal resection techniques.